Compliance Plan 2020 - Home - Regal Medical Group

HERITAGE PROVIDER NETWORK

&

AFFILIATED MEDICAL GROUPS

Compliance Plan

2020

Affiliated Medical Groups

ADOC Medical Group

Bakersfield Family Medical Center

Coastal Communities Physician Network

Desert Oasis Health Care

Greater Covina Medical Group

Heritage Sierra Medical Group

Heritage Victor Valley Medical Group

High Desert Medical Group

Lakeside Medical Group

Regal Medical Group

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Table of Contents

Message from HPN President and CEO ..................................................................................................... 6

HPN Program Effectiveness Evaluation ..................................................................................................... 7

Best Practices .......................................................................................................................................... 7

Introduction ............................................................................................................................................... 10

Mission .................................................................................................................................................. 10

Vision .................................................................................................................................................... 10

Statement of Values .............................................................................................................................. 10

Objective of the Program ...................................................................................................................... 10

Standards of Conduct, Confidentiality, and Agreement of Compliance ............................................... 11

Compliance Plan ....................................................................................................................................... 14

Written Standards of Conduct ............................................................................................................... 14

Role of Corporate Compliance Officer (CCO) ..................................................................................... 14

Corporate Compliance Committee ........................................................................................................ 15

Reporting and Confidentiality ............................................................................................................... 16

Investigating Compliance Issues ........................................................................................................... 17

Corrective Action Plan .......................................................................................................................... 18

Annual Compliance Review and Reporting .......................................................................................... 19

Education and Training ............................................................................................................................. 21

Compliance Education .......................................................................................................................... 21

Employee Code of Conduct ...................................................................................................................... 22

Standards of Conduct ............................................................................................................................ 22

Evaluation of Employee Performance................................................................................................... 22

Employee¡¯s Obligation to Report .......................................................................................................... 23

Controlled Substance............................................................................................................................. 23

Copyrights ............................................................................................................................................. 23

Harassment and Workplace Violence ................................................................................................... 23

Treat All Employees with Respect, Dignity and Fairness .................................................................... 24

Health & Safety ..................................................................................................................................... 25

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Personal Use of Resources .................................................................................................................... 25

Relationships with Healthcare Constituents .......................................................................................... 26

Substance Abuse and Mental Acuity .................................................................................................... 26

Payments, Discounts and Gifts.............................................................................................................. 27

Fair Dealing ........................................................................................................................................... 28

Conflicts of Interest................................................................................................................................... 29

Conflicts of Interest ............................................................................................................................... 29

Outside Employment and Activities ..................................................................................................... 30

Misuse of Company Resources ............................................................................................................. 30

Quality of Care and Services .................................................................................................................... 31

Quality of Care and Services ................................................................................................................. 31

Federal, State and Legal Regulatory Compliance..................................................................................... 32

Fraud, Waste and Abuse........................................................................................................................ 32

Fraud, Waste, and Abuse Reporting...................................................................................................... 32

Anti-fraud Program ............................................................................................................................... 33

Under-provision of Services.................................................................................................................. 34

Federal False Claims Act, Program Fraud Civil Remedies Act, State False Medicaid Claims Act ..... 34

Anti-Kickback Statute and Stark Law ................................................................................................... 35

Balance Billing ...................................................................................................................................... 36

Fee Splitting and Anti-Markup Laws .................................................................................................... 36

Certificate of Need ................................................................................................................................ 36

State Registration and Licensure Requirements.................................................................................... 37

Insurance Laws Relating to Risk-Bearing Provider Networks ............................................................. 37

Response to Government Investigations ............................................................................................... 37

Environmental Compliance ...................................................................................................................... 38

Environmental Compliance ................................................................................................................... 38

Marketing, Fundraising and Political Activities ....................................................................................... 39

Antitrust Laws ....................................................................................................................................... 39

Marketing of Healthcare Services ......................................................................................................... 39

Fundraising and Contributions .............................................................................................................. 40

Political Activities ................................................................................................................................. 40

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Solicitation of Unrelated Business Activities........................................................................................ 40

Media Relations..................................................................................................................................... 41

Gathering Information about Competitors ............................................................................................ 41

Fiscal Responsibility/Cost Effectiveness .................................................................................................. 42

Accuracy of Financial Records ............................................................................................................. 42

Billing, Charging & Coding for Services .............................................................................................. 43

Financial Disclosure .............................................................................................................................. 43

Loans ..................................................................................................................................................... 44

Civil Monetary Penalties ....................................................................................................................... 44

Credit Balance ....................................................................................................................................... 44

Information Security, Confidentiality and Retention................................................................................ 45

Information Security ............................................................................................................................. 45

HIPAA Privacy and Security Compliance ............................................................................................ 45

Mitigation of Privacy and Security Violations ...................................................................................... 46

Record Retention ................................................................................................................................... 46

Use of Proprietary Information ............................................................................................................. 47

Electronic Media ................................................................................................................................... 47

Conclusion............................................................................................................................................. 47

Revision dates: 05/2013, 10/2014, 5/2015, 7/2016, 1/2017, 11/2017, 02/2018, 09/2018, 01/2019, 04/2019,

07/2019, 01/2020

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